TOTAL LAPAROSCOPIC

HYSTERECTOMY
using
SINGH
MANIPULATOR, FUNNEL and HANDSFREE
PELVIC ASSISTANT (PA)
 Instruments used

Uterine Manipulator HANDSFREE (PA)

PELVIC ASSISTANT
Vaginal Funnel
Uterine Artery Needle
Tie
Uterine Hook Dissector
Pelvic Probes
Vaginal Plug
 SET UP

Place patient in lithotomy.

Make sure the symphysis pubis is over
the end of the operating table, not just the
buttocks. This will ensure that maximum
anteversion can be achieved when required.
INSERT FOLEY’S
CATHETER.
ATTACH VULSELLUM TO
CERVIX.
DILATE CERVIX WITH
STRAIGHT END OF INNER ROD.
DO NOT DILATE ANY MORE
THAN DIAMETER OF INNER
ROD.
SOUND THE LENGTH OF THE
UTERINE CAVITY WITH THE
INNER ROD.
INSERT CURVED END OF
MANIPULATING ROD INTO
CERVIX UP TO UTERINE
FUNDUS. USE STRAIGHT ROD
FOR LSH, AS ROD CAN BE
RETRACTED FROM UTERUS
DURING MORSELLATION.
SLIDE UTERINE CANNU
MANIPULATING ROD UP
CERVIX.
HOLD ON TO ROD WITH
OTHER HAND TO PREV
FROM BEING PUSHED P
FUNDUS.
SCREW CANNULA INTO CERVIX
LEVEL OF THE O RING.
IN FIRST FEW CASES, I SUGGES
PLACING A STAY SUTURE (1 NYL
AT 12 O’CLOCK ON THE ECTOCE
AND TIE AROUND THE CANNULA
FEW TIMES. REPEAT AT 3 O’CLO
OS IS PATULOUS OR UTERUS IS
LARGE.
THIS WILL ALLOW YOU TO DELIV
THE UTERUS AT THE END OF TH
PROCEDURE. OTHERWISE YOU W
HAVE TO INSERT A VULSELLUM
THE VAULT TO GRAB THE CERV
MANIPULATOR SCREWED
INTO CERVICAL OS
SLIDE FUNNEL ALONG UTERINE
CANNULA.
REMOVE VULSELLUM FROM
CERVIX.
PUSH FUNNEL ALONG UTERINE
CANNULA INTO VAGINA WITH
THE EDGE OF THE FUNNEL
PLACED POSTERIORLY.
PUSH FUNNEL FIRMLY INTO THE
VAGINA AGAINST THE VAGINAL
VAULT.
FUNNEL ON MANIPULATOR
PLACE BLACK OR WHITE
HOLDING SCREW BEHIND
FUNNEL SHAFT TO PREVENT IT
SLIPPING OUT OF THE VAGINA.
YOUR PELVIC ASSISTANT NOW
HOLDS THE CANNULA OR YOU
CAN ATTACH IT TO THE
HANDSFREE PA.
THIS IS THE FINAL SET UP IN THE PATIENT.
ROTATE THE FUNNEL SHAFT TO PRESENT
THE EDGE FOR DISSECTION.
PLEASE NOTE NEW SINGLE PIECE
FUNNELS HAVE REPLACED SCREW ON
MODELS.
THE INNER ROD CAN BE PUSHED,
WITHDRAWN OR ROTATED UNDER
LAPAROSCOPIC CONTROL TO
FURTHER MANIPULATE THE UTERUS.
VAGINAL
PLUG TO
STOP CO2
LEAK
DURING
COLPOTOM
Y. PUSH
ONTO
FUNNEL
WHEN LEAK
OCCURS.
PUSH PLUG
ONTO FUNNEL
TO BLOCK
INTROITUS
ONLY WHEN
LEAK OCCURS